Sunday, 23 May 2010

TurpTurpTurp

Hi,

A very different week compared to last week's excitement, but at least I now know that I don't want to be a urologist! Seeing as we get to see a bit of everything on the rotation, I suppose a lot of time is spent working out what you don't want to do. If you wanted to do everything, well, you couldn't.

As the first paragraph suggests, this week was spent doing urology surgery. Perhaps it is a little premature for me to say this so prematurely, but if I ended up having to go into urology surgery, I would probably leave medicine and go into something different. Perhaps I could joint he police force, being a detective looks exciting from TV.

Not that my experience this week was a bad one. The teachers had plenty of time for us, and in theatre we were walked through what was going on in a friendly manner. The low point here was that we didn't get to assist or scrub in at all this week, but that's just because of the procedure that was being carried out.

Yes, that's right - a whole week of surgery and I only saw one procedure. No - it wasn't just one chance in the theatre, had plenty of those opportunity - it was just the same procedure again and again. While surgeons in urology do carry out a range of operations, from surgical treatment of bladder cancer to operations on the kidneys, there is one operation they do far more than any other. This is called the TURP, which stands for Transurethral Resection of Prostate. Sounds pretty fancy, doesn't it!

Enlarged prostates are very common (in men, obviously) and cause a range of problems with urination by putting pressure on the urethra. The prostate is basically like a ring doughnut, the middle of which the urethra passes through. As the prostate grows, this puts pressure on the urethra, making it harder to urinate. Prostates can enlarge by themselves, for no obvious reason, or they can be cancerous. Whatever the reason for their enlargement, if the patient wants to be able to go to the toilet normally this is the operation for them.

We saw one on Monday and it looked pretty exciting. A tube is passed up the urethra via the end of the penis, up into the bladder, as though the patient was being catheterised. This tube is larger than a catheter, though, and the doctor passes an instrument similar to an endoscope up through the tube with a camera on it in order to visualise the bladder and urethra. With this camera another instrument can be passed up, which looks like a loop of wire, and used to cut away at the prostate encroaching on the urethra - see below.

Here you can see the insertion of the tube down to the level of the prostate, which can be operated on (see small organ above and below the tip of the tube)

This is the image the surgeon can see. The operation from this point on is carried out by feel and what can be seen in the camera. The wire loop can be seen, and is linked up to a diathermy, using electricity to cut through the prostate and seal the blood vessels after the cut is made.

The tube also has to pump water continuously into the urethra and bladder in order to make the tube as open as possible, to make the operation easy.

Now you can see why it was not possible for us to assist - this is carried out by one surgeon with anaesthetist(s), assistant theatre technicians and nurses there to help with the procedure. It still sounds like a lot, but the operating theatre would have been pretty empty, comparative to normal, if it weren't for all of the medical students standing in the corner peering at the screen.

The surgeon works the loop around the urethra, making the hole bigger by cutting away bits of prostate from the inside. This damages the urethra as well, but like when you graze your knee, the surface will just grow back again, so that is no worry. With bloody water being pumped out of the patient's penis, and the surgeon working away, as I said before, this seems like quite an interesting surgery. But then it just goes on and on. And on. The surgeon is working away, shaving little bits of prostate away for some time, and then another patient comes in, and exactly the same thing is carried out. Starting to get a little boring. Then another. You get the picture.

That was only the first day - the rest of the week consisted of seeing more and more TURPs, there were some performed by LASERS! Again, sounds exciting in principal, but just involves a slightly different instrument being used, a small spark on the screen, and the instrument being moved around for some time within the vision, slowly singeing back the prostate to allow the passage of urine. Not thrilling.

The rest of the week, when we were not in these theatre sessions, involved talking to patients (again, always the positive of the weeks) and being taught by the interested doctors.

Now, I am not saying that this is all urologists do - I am assured there are other operations, but I personally wouldn't want to do more than one or two of these operations a week, it just seems so mundane. It is not even like being a physician and treating pneumonia after pneumonia. At least there patients are able to chat with you, you have plenty of confounding factors to take into account and a thousand and one other interesting sidelines possible. Here a patient comes in, is treated, leaves and repeated. You may as well be assembling things on a factory production line. A very necessary job, and I am glad that someone does it, but not for me, thanks!

With that, I will have to depart. Had a lovely BBQ in the sun today, and got some work done, which is nice - hoping to keep it rolling. Next week will be more interesting, I can smell it!

2 comments:

ooh i know how boring surgery can be when you are performing the same procedure over and over again!!! i encountered this during my ophthal rotation which is 6 weeks ( too many i might add ). I got to see a cataract operation on our OR day ( which 3 times a week ). And another operation and another one and on and on... so boring. so i empathise with you !!!